Metastatic gestational trophoblastic neoplasm. A study of two cases in unusual clinical settings and review of the literature.

Two cases of metastatic gestational trophoblastic neoplasms (MGTN) diagnosed by mediastinoscopic and gastroscopic biopsies, respectively, are presented. Both patients are young women who presented with hemorrhagic events involving the CNS in one case and the gastrointestinal tract in the other, with histories of recent pregnancies. Both cases belong to the group of high-risk MGTN because of the location of the metastatic lesions (CNS and liver) and because of the delayed onset of chemotherapy. One patient is in clinical remission, 3 years later, and the other succumbed to her disease. A review of the literature suggests that CNS involvement has a better prognosis than liver metastases. The patient diagnosed to have MGTN by a gastroscopic biopsy is the first reported, to the best of out knowledge. The outcome of MGTN, although greatly improved by chemotherapy, is still fatal in numerous cases in the high-risk group. Since an early diagnosis is critical for successful chemotherapy, it is advisable to perform HCG titers in the blood serum of young patients presenting with unexplained hemorrhagic events, especially in those with recent gestations.